Lipomatosis of the filum terminale

Patient Data

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Sagittal non-contrast

Non contrast CT of the lumbar spine demonstrates a strip of fat density located within the dura and extending from the superior aspect of L2 to L3/4. Degenerative disc change at L3/4 is present with marked disc height loss and end plate sclerosis.

On these images the location of the conus cannot be identified, but can be assumed to be at or above the level of L1/2.

A: It would be ignored, provided there were no symptoms suggestive of tethered cord. If there were then treatment is controversial and depends on the severity and specificity of the symptoms.

Case Discussion

This case is typical of incidentally identified lipomatosis of the filum terminale in a patient symptomatic from degenerative change. The absence of a low lying conus and relatively thin filum (<2mm at the level of L5/S1) further suggests that this is an incidental asymptomatic finding.